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Sunday, May 14, 2017

The “Newcastle
Diet,” as it seemingly is practiced today, is not the same as the original diet
developed at Newcastle University for their “Counterpoint Study,” conducted in
2009 and published in 2011. I wrote about this study four years ago in "Reversal of Type 2 Diabetes"
(#88) and "'Reversal of Type 2 Diabetes' Revisited" (#89). Column #88 garnered the most page
views of any column I have ever published due to the appealing but misleading
title. Note: My column titles were in
quotes because they are the paper’s authors,’ not mine.

The author’s use
of “reversal” in the title is misleading because of their definition of
“reversal”: “Reversal of diabetes” was defined
by them as “achieving fasting capillary blood glucose < 6.1mmol/l
[110mg/dl] and/or, if available, HbA1c less than 43 mmol/mol (6.1%) off
treatment.” In my book, that is neither a “reversal” nor a “cure,” as some
would claim. A FBG of 110 is smack in the middle of “pre-diabetic” (which
begins at 100mg/dl (5.6mmol/L) in the U.S). By way of reference, many doctors
consider an A1c of 5.7% (39 mmol/mol) – the threshold for “pre-diabetes” – to
be incipient type 2 diabetes. That’s because it’s manifest evidence of Insulin
Resistance (IR), the cause of type 2
diabetes. “Pre-diabetes” is simply an arbitrary point on the IR continuum.

Why is the
Newcastle Diet called the “600 kcal diet”? Quoting from the Newcastle University 2011 paper,
the dietary protocol of the “Counterpoint Study,” “consisted of a liquid diet formula (46.4%
carbohydrate, 32.5% protein and 20.1% fat; vitamins, minerals and trace
elements; 2.1 MJ/day [510 kcal/day]; Optifast; Nestlé Nutrition,
Croydon, UK). This was supplemented with three portions of non-starchy
vegetables such that total energy intake was about 2.5 MJ
(600 kcal)/day.” That’s why the Newcastle Diet is called the “600
calorie diet.”

However, Diabetes.co.uk, which funded the study and has the only official description of it on the
web, now says it is 800 kcal diet,
comprised of “Optifast meal replacement sachets, which provided 75% of the
calories (600 calories). The other 200 calories came from non-starchy
vegetables.” Then, “Note: The diet is referred to as the 600 calorie diet
(rather than 800) due to the meal replacement aspect of the diet totaling 600
calories.” Wrong! The Optifast portion is 510 kcal, but I guess NHS doesn’t
want Brits trying such a “drastic” (600k cal total) diet, and certainly not
“without the help and approval of a dietitian or doctor.” Good luck with that!

Note also the
macronutrient composition of the Optifast part of the original
Newcastle Diet: 46.4% carbs, 32.5% protein, and 20.1% fat. That’s high
carb, very high protein and low fat. And that’s not counting the 3 servings of
“non-starchy vegetables,” which if you ate them would boost the carb content higher, to 55% of the 600 kcal diet and 66% carbs in the 800 kcal diet. That ishow you developed diabetes in the first place!

In addition, the
32.5% protein is much too high. Virtually
no one recommends more than 30%, and hardly anyone eats more than 20%.
Americans eat 15% on average, and the Nutrition Facts panel on packaged and
processed foods is based on 10% protein. Any protein that your body does not
take up in 4 or 5 hours is stored in the liver and is used to make glucose (or fat!). In T2s, suppressing this unwanted
gluconeogenesis is one of the things that Metformin does. So, basically, Newcastle is a low-dietary-fat diet, but
since your body has access to its own fat for fuel, if you burn a pound a week,
it’s a pretty HIGH-FAT diet AT THE CELLULAR LEVEL.

Okay, so why
does this diet work? The answer is that it is fundamentally a
very low CALORIE diet. On this the authors agree. They conclude,
“Normalization of both beta cell function and hepatic insulin sensitivity in
type 2 diabetes was achieved by
dietary energy restriction alone” (my emphasis). Makes sense. You eat
less. You lose weight. In this respect the Newcastle diet is similar, both in
mode and outcomes, to bariatric surgery…but tremendously safer. And in lieu of
the 300g of carbohydrates that the typical Western 2,000 kcal diet includes,
the original Counterpoint Study (600 kcal) version would have 59g of carbs from
Optifast and 23.5g added for “non-starchy vegetables” = 82.5g total. So, in addition to being very low in
DIETARY fat, the original Newcastle is
low carb! In the higher-fiber
800 kcal version recommended by Diabetes.co.uk, the carb count climbs to 132
grams, no longer considered “low-carb,” but it’s still pretty low compared to
300 or 375! Good for the gut too.

300g of carbs is the
RDA in a 2,000kcal diet; 375g in 2,500kcal (for men). Surely everyone knows, even if the NHS and the ADA and the public
health establishment won’t admit it, TYPE 2 DIABETES IS A DIETARY DISEASE. As such, the best treatment for type 2 diabetes is a HIGH fat, moderate
protein, LOW carbohydrate diet.

38 comments:

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About Me

I was diagnosed a Type 2 diabetic in 1986. I started a Very Low Carb diet (Atkins Induction) in 2002 to lose weight. I didn’t realize at the time that it would put my diabetes in clinical remission, or that I would be able to give up almost all of my oral diabetes meds. I also didn’t understand that, as I lost weight and continued to eat Very Low Carb, my blood lipids would dramatically improve (doubling my HDL and cutting my triglycerides by 2/3rds) and that my blood pressure would drop from 130/90 to 110/70 on the same meds.
Over the years I changed from Atkins to the Bernstein Diet (designed for diabetics) and, altogether lost 170 pounds. I later regained some and then lost some. As long as I eat Very Low Carb, I am not hungry and I have lots of energy. And I no longer have any of the indications of Metabolic Syndrome.
My goal, as long as I have excess body fat, is to remain continuously in a ketogenic state, both for blood glucose regulation and continued weight loss. I expect that this regimen will continue to provide the benefits of reduced systemic inflammation, improved blood lipids and lower blood pressure as well.